Reposable multi-fire surgical clip applier

ABSTRACT

A reposable surgical clip applier includes a handle assembly, a shaft assembly releasably engagable with the handle assembly, and a clip cartridge assembly releasably engagable within the shaft assembly. The handle assembly includes at least one handle, a proximal drive member, a proximal pusher, and a handle spring assembly configured to bias the handle(s) towards a spaced-apart position. When the reposable surgical clip applier is assembled, the proximal drive member is positioned proximally adjacent an inner drive assembly of the shaft assembly such that movement of the handle(s) towards an approximated position actuates a jaw assembly of the shaft assembly. When the reposable surgical clip applier is assembled, the proximal pusher is positioned proximally adjacent a distal pusher of the clip cartridge assembly such that movement of the handle(s) towards the spaced-apart position loads a distal-most surgical clip from the clip cartridge assembly into the jaw assembly.

CROSS-REFERENCE TO RELATED APPLICATION

This application claims the benefit of and priority to U.S. ProvisionalPatent Application No. 62/598,437 filed Dec. 13, 2017, the entiredisclosure of which is incorporated by reference herein.

BACKGROUND Technical Field

The present disclosure relates to surgical clip appliers and, moreparticularly, to a reposable multi-fire surgical clip applier includinga handle assembly, a shaft assembly, and a clip cartridge assembly thatare configured for selective disassembly to facilitate disposal of anydisposable component(s) and reprocessing of any reusable component(s)for further use.

Discussion of Related Art

Various staplers and clip appliers are known in the art and used for anumber of distinct and useful surgical procedures. Clip appliers thatare able to apply multiple clips during a single entry into a bodycavity, for example, are described in commonly-assigned U.S. Pat. Nos.5,084,057 and 5,100,420 to Green et al., the entire contents of whichare incorporated herein by reference. Another multiple clip applier isdisclosed in commonly-assigned U.S. Pat. No. 5,607,436 by Pratt et al.,the entire contents of which is also hereby incorporated herein byreference. U.S. Pat. No. 5,695,502 to Pier et al., the entire contentsof which is hereby incorporated herein by reference, discloses aresterilizable surgical clip applier that is configured to receive andcooperate with an interchangeable clip magazine so as to advance andform multiple clips during a single entry into a body cavity.

SUMMARY

The present disclosure relates to a reposable multi-fire surgical clipapplier including a handle assembly, a shaft assembly, and a clipcartridge assembly that are configured for selective disassembly tofacilitate disposal of any disposable component(s) and reprocessing ofany reusable component(s) for further use.

A reposable surgical clip applier provided in accordance with aspects ofthe present disclosure includes a handle assembly, a shaft assemblyreleasably engagable with the handle assembly, and a clip cartridgeassembly releasably engagable within the shaft assembly.

The handle assembly includes a housing, at least one handle movablerelative to the housing between a spaced-apart position and anapproximated position, and an inner actuation assembly extending fromthe housing. The inner actuation assembly includes a proximal drivemember movable through the housing, a proximal pusher bar movablethrough the proximal drive member, and a handle spring assembly. Thehandle spring assembly includes at least one spring arm engaging the atleast one handle to bias the at least one handle towards the spacedapart position. Movement of the at least one handle relative to thehousing is configured to move the proximal drive member and the proximalpusher bar in relative opposing directions.

The shaft assembly includes an outer tube, a jaw assembly supported at adistal end portion of the outer tube, and an inner drive slidablydisposed within the outer tube and operably coupled to the jaw assemblysuch that distal movement of the inner drive through the outer tubeactuates the jaw assembly.

The clip cartridge assembly retains a stack of surgical clips thereinand includes a distal pusher operably coupled to a distal-most surgicalclip of the stack of surgical clips such that distal movement of thedistal pusher loads the distal-most surgical clip into the jaw assemblywhen the clip cartridge assembly is releasably engaged within the shaftassembly.

When the shaft assembly is releasably engaged with the handle assemblyand the clip cartridge assembly is releasably engaged within the shaftassembly, the proximal drive member is positioned proximally adjacentthe inner drive assembly such that movement of the at least one handletowards the approximated position actuates the jaw assembly, and theproximal pusher bar is positioned proximally adjacent the distal pushersuch that movement of the at least one handle towards the spaced-apartposition loads the distal-most surgical clip into the jaw assembly.

In one aspect of the present disclosure, the handle spring assemblyincludes a transverse body portion releasably retained within a proximalend portion of the housing. In such aspects, the transverse body portiondefines a bore configured to be in communication with the outer tube ofthe shaft assembly such that, the proximal drive member is movablethrough the bore of the handle spring assembly to engage the inner driveassembly of the shaft assembly upon movement of the at least one handle.

In embodiments of the present disclosure, the at least one spring arm ofthe handle spring assembly extends outwardly from the transverse bodyportion and includes a free proximal end portion. In such embodiments,the free proximal end portion of the at least one spring arm is slidablealong the at least handle upon movement of the at least one handle.

In another aspect of the present disclosure, the housing includes atleast one internal feature defining a pivot recess configured to movablyreceive a distal end portion of the at least one handle. In suchaspects, the pivot recess and the at least one handle are sized andconfigured to cooperate to limit movement of the at least one handlebeyond a predetermined approximated position and beyond a predeterminedspaced-apart position.

In still another aspect of the present disclosure, movement of the atleast one handle towards the approximated position moves the proximaldrive member distally about the proximal pusher bar and moves theproximal pusher bar proximally about and through the proximal drivemember. In such aspects, movement of the at least one handle towards thespaced-apart position moves the proximal drive member proximally aboutthe proximal pusher bar and moves the proximal pusher bar distally aboutand through the proximal drive member.

In embodiments of the present disclosure, the clip cartridge assemblyfurther includes a biasing member configured to bias the distal pusherproximally.

In aspects of the present disclosure, the clip cartridge assemblyfurther includes a cartridge housing having a support base configured tosupport at least a portion of the distal pusher. The support baseincludes a distal bridge portion and a proximal bridge portion. In suchaspects, the biasing member of the cartridge assembly is operablycoupled to the distal pusher and to the proximal bridge portion to biasthe distal pusher proximally.

In another aspect of the present disclosure, the clip cartridge assemblyfurther includes a clip carrier including a pair of engagement flanges.In such aspects, the cartridge housing includes a pair of internalgrooves extending longitudinally along at least a portion of a length ofthe cartridge housing. In such aspects, the pair of internal grooves maybe configured to laterally receive the pair of engagement flanges,respectively, to inhibit axial movement of the clip carrier relative tothe cartridge housing.

In still another aspect of the present disclosure, the clip cartridgeassembly further includes a carrier lock disposed proximally adjacent aproximal end portion of the clip carrier. In such aspects, the carrierlock includes a pair of opposing arms configured to biasingly engage apair of opposing internal walls of the cartridge housing, wherein thecarrier lock is configured to inhibit proximal movement of the clipcarrier relative to the cartridge housing beyond the carrier lock.

In embodiments of the present disclosure, the housing of the handleassembly includes an open distal end portion defining a centralpassageway and a protrusion extending inwardly into the centralpassageway. In such embodiments, the shaft assembly includes a tubularproximal segment defining a slot configured to receive the protrusionupon insertion of the tubular proximal segment into the open distal endportion to releasably engage the shaft assembly with the handleassembly.

In aspects of the present disclosure, the shaft assembly furtherincludes an inner bushing disposed between the tubular proximal segmentand the inner drive assembly. In such aspects, the inner bushing has aslot configured to be axially aligned with the slot of the tubularproximal segment when the inner bushing is disposed therein. In suchaspects, the protrusion extending inwardly from the housing is receivedwithin the slot of the tubular proximal segment and the slot of theinner bushing.

In another aspect of the present disclosure, the handle assemblyincludes a pair of handles pivotably coupled to the housing andextending from opposed sides thereof.

In yet another aspect of the present disclosure, the handle springassembly includes a transverse body portion releasably retained within aproximal end portion of the housing and a pair of spring arms extendingoutwardly from opposing sides of the transverse body portion. In suchaspects, each spring arm of the pair of spring arms are configured toengage a respective handle of the pair of handles to bias the pair ofhandles towards the spaced-apart position.

In embodiments of the present disclosure, the pair of spring arms eachincludes a free proximal end portion configured to slide along therespective handle of the pair of handles upon movement of the pair ofhandles.

In aspects of the present disclosure, the handle assembly furtherincludes a linkage assembly configured to pivotably couple the pair ofhandles to the inner actuation assembly. In such aspects, the linkageassembly includes a first link arm configured to operably couple a firsthandle of the pair of handles to the proximal drive member and a secondlink arm configured to operably couple a second handle of the pair ofhandles to the proximal pusher bar. In such aspects, upon movement ofthe pair of handles towards the approximated position, the first linkarm is configured to move the proximal drive member distally and thesecond link arm is configured to move the proximal pusher barproximally. In such aspects, upon movement of the pair of handlestowards the spaced-apart position, the first link arm is configured tomove the proximal drive member proximally and the second link arm isconfigured to move the proximal pusher bar distally.

In another aspect of the present disclosure, the linkage assembly isconfigured to move the proximal drive member concurrently with theproximal pusher bar upon movement of the pair of handles.

In embodiments of the present disclosure, linkage assembly furtherincludes a third link arm configured to operably couple the secondhandle of the pair of handles to the proximal drive member and a fourthlink arm configured to operably couple the first handle of the pair ofhandles to the proximal pusher bar.

In another aspect of the present disclosure, the proximal pusher bar isconfigured to move between the first link arm and the third link arm asthe proximal pusher bar moves through the proximal drive member.

A reposable surgical clip applier provided in accordance with anotheraspect of the present disclosure includes a handle assembly. The handleassembly includes a housing having at least one internal feature, afirst and a second handle movable relative to the housing between aspaced-apart position and an approximated position, and an inneractuation assembly disposed within the housing and operably coupled tothe first handle and the second handle.

The inner actuation assembly includes a proximal drive member defining alumen, a proximal pusher bar slidably disposed within the lumen of theproximal drive member and movable in relation to the proximal drivemember, a handle spring assembly, and a linkage assembly.

The handle spring assembly includes a transverse body portion supportedwithin the at least one internal feature of the housing and a firstspring arm and a second spring arm each extending outwardly fromopposing lateral sides of the transverse body portion. The first springarm is configured to engage the first handle and the second spring armis configured to engage the second handle, such that, the first handleand the second handle are biased towards the spaced-apart position.

The linkage assembly is configured to pivotably couple the first handleand the second handle to the inner actuation assembly. When the firsthandle and the second handle are moved relative to the housing, theproximal drive member and the proximal pusher bar are configured to movein relative opposing directions.

In embodiments of the present disclosure, the reposable surgical clipapplier further includes a shaft assembly releasably engagable with thehandle assembly and a clip cartridge assembly releasably engagablewithin the shaft assembly.

BRIEF DESCRIPTION OF THE DRAWINGS

Aspects and features of a reposable multi-fire surgical clip applier areprovided in accordance with the present disclosure with reference to thedrawings wherein:

FIG. 1 is a top, perspective view of a reposable multi-fire surgicalclip applier provided in accordance with the present disclosure, shownin an assembled condition with a handle assembly thereof in aspaced-apart position;

FIG. 2 is a top view of the surgical clip applier of FIG. 1, with thehandle assembly thereof in an approximated position;

FIG. 3 is a front, perspective view, with parts separated, of a clipcartridge assembly of the surgical clip applier of FIG. 1;

FIG. 4 is a top view of the clip cartridge assembly of the surgical clipapplier of FIG. 3;

FIG. 5 is a bottom view of the clip cartridge assembly of FIG. 4;

FIG. 6A is a cross-sectional view taken across section line “6A-6A” inFIG. 4;

FIG. 6B is a bottom, perspective view of the area of detail indicated as“6B” in FIG. 5;

FIG. 6C is a top, perspective view of the area of detail indicated as“6C” in FIG. 1;

FIG. 7 is a longitudinal, cross-sectional view taken across section line“7-7” of FIG. 4;

FIG. 8 is an enlarged, longitudinal, cross-sectional view of the area ofdetail indicated as “8” in FIG. 7;

FIG. 9 is an enlarged, longitudinal, cross-sectional view of the area ofdetail indicated as “9” in FIG. 7;

FIG. 10 is a top, perspective view of a shaft assembly of the surgicalclip applier of FIG. 1;

FIG. 11 is a side view of the shaft assembly of FIG. 10;

FIG. 12 is a top view of the shaft assembly of FIG. 10;

FIG. 13 is a longitudinal, cross-sectional view taken across sectionline “13-13” of FIG. 12;

FIG. 14 is a top, perspective view, with parts separated, of the shaftassembly of FIG. 13;

FIG. 15 is a top, perspective view of a handle assembly of FIG. 1, witha housing section removed to illustrate the internal components therein;

FIG. 16 is an enlarged, top, perspective view of the area of detailindicated as “16” in FIG. 15;

FIG. 17 is a front, perspective view, of the surgical clip applier ofFIG. 1, with the clip cartridge assembly removed;

FIGS. 18 and 19 are top, perspective views illustrating engagement ofthe clip cartridge assembly of FIG. 3 with the shaft assembly of FIG.10;

FIG. 20 is a longitudinal, cross-sectional view taken across sectionline “20-20” of FIG. 1;

FIG. 21 is a top view of a distal portion of the surgical clip applierof FIG. 1;

FIG. 22 is an enlarged, front, perspective view of a distal end portionof the surgical clip applier of FIG. 1 with components shown in phantomto illustrate internal features of the surgical clip applier; and

FIG. 23 is a schematic illustration of a robotic surgical systemconfigured for use in accordance with the present disclosure.

DETAILED DESCRIPTION OF EMBODIMENTS

A reposable multi-fire surgical clip applier in accordance with thepresent disclosure is described in detail below with reference to thedrawing figures wherein like reference numerals identify similar oridentical structural elements. As shown in the drawings and describedthroughout the following description, as is traditional when referringto relative positioning on a surgical instrument, the term “proximal”refers to the end portion of the apparatus or component thereof which iscloser to the user and the term “distal” refers to the end portion ofthe apparatus or component thereof which is further away from the user.

Referring now to FIGS. 1 and 2, a surgical clip applier in accordancewith an embodiment of the present disclosure is generally designated as10. Surgical clip applier 10 includes a handle assembly 100, a shaftassembly 200 extending distally from handle assembly 100, and a clipcartridge assembly 300 mounted within shaft assembly 200. Shaft assembly200 is removably and selectively engagable with handle assembly 100 andclip cartridge assembly 300 is removably and selectively mountablewithin shaft assembly 200. Handle assembly 100 and shaft assembly 200may be configured as sterilizable, reusable components, while clipcartridge assembly 300 may be configured as a single-procedure-usecomponent. As described in detail below, a stack of surgical clips “C”(FIG. 3) is loaded into clip cartridge assembly 300 such that, inoperation, each actuation of handle assembly 100 actuates cooperatingdrive components of handle assembly 100, shaft assembly 200, andcartridge assembly 300 to fire and form a single surgical clip from thestack of surgical clips “C” (FIG. 3) around a vessel or other tissue toligate the vessel or other tissue.

Referring to FIGS. 3-9, clip cartridge assembly 300 includes a cartridgehousing or housing 310, a clip carrier 320, a clip follower 330, adistal pusher 340, a slider 350, a first biasing member 360, a secondbiasing member 370, a carrier lock 380, and a stack of surgical clips“C.”

With reference to FIGS. 3, 6A, and 6B, cartridge housing 310 includes anupper housing portion 310 a, a lower housing portion 310 b, and aninternal cavity 312 extending along a length of the cartridge housing310 between a distal end portion and a proximal end portion thereof.Cartridge housing 310 may be formed at least partially from atransparent material, such as, for example, a transparent plastic, toenable visualization into internal cavity 312 thereof. Cartridge housing310 includes a pair of internal grooves 314 a, 314 b extendinglongitudinally along at least a portion of the length of the cartridgehousing 310, on opposing internal walls 311 a, 311 b thereof. The pairof internal grooves 314 a, 314 b are configured to retain clip carrier320 and carrier lock 380 when clip carrier 320 and carrier lock 380 aredisposed within internal cavity 312 of cartridge housing 310, as will bedetailed below. Internal cavity 312 of cartridge housing 310 is alsoconfigured to receive at least a portion of clip follower 330, distalpusher 340, slider 350, first biasing member 360, second biasing member370, and the stack of surgical clips “C” therein.

With reference to FIGS. 3-6A, upper housing portion 310 a of cartridgehousing 310 includes a window 316 formed therein and configured toslidably receive a cap portion 352 of slider 350. Cartridge housing 310includes a protrusion 317 extending transversely into proximal window316 from a side thereof. Cap portion 352 of slider 350 defines amore-proximally positioned recess 353 a defined on a side thereof and amore-distally positioned recess 353 b defined on the same side thereof.More-proximally positioned recess 353 a is configured to receiveprotrusion 317 of cartridge housing 310 to releasably retain slider 350in a distal position relative to cartridge housing 310. Upon sufficientproximal urging of cap portion 352 of slider 350 relative to cartridgehousing 310, protrusion 317 of cartridge housing 310 is dislodged frommore-proximally positioned recess 353 a of cap portion 352 of slider350, enabling slider 350 to slide proximally through window 316. Onceslider 350 is slid sufficiently proximally, protrusion 317 is engagedwithin more-distally positioned recess 353 b of cap portion 354 ofslider 350 to thereby releasably retain slider 350 in a proximalposition relative to cartridge housing 310. The proximal and distalpositions of slider 350 are described in detail hereinbelow.

With continued reference to FIGS. 3-6A, lower housing portion 310 b ofcartridge housing 310 includes a support base 313 configured to encloseand support at least a portion of distal pusher 340 when distal pusheris disposed within internal cavity 312 of cartridge housing 310 (FIG.5). Support base 313 includes a first or distal bridge portion 313 a anda second or proximal bridge portion 313 b extending between and coupledto lateral sides of cartridge housing 310. In embodiments, the first andsecond bridge portions 313 a, 313 b are longitudinally spaced apart andat least a portion of distal pusher 340 is disposed thereon. Secondbridge portion 313 b includes an aperture or slot 313 c configured toreceive a proximal end portion 372 of second biasing member 370 thusfixing proximal end portion 372 of second biasing member 370 relative tocartridge housing 310, as will be further detailed below. Inembodiments, lower housing portion 310 b of cartridge housing 310 mayinclude more than two bridge portions or may be entirely enclosed.

With reference to FIGS. 3, 6A, and 6B, clip carrier 320 of clipcartridge assembly 300 includes a floor 324 and a pair of side walls 326a, 326 b extending longitudinally along the opposed sides of floor 324such that clip carrier 320 defines a generally U-shaped configuration.Clip carrier 320 includes a pair of engagement flanges 322 a, 322 bconfigured to engage the pair of internal grooves 314 a, 314 b ofopposing internal walls 311 a, 311 b, respectively, of cartridge housing310. Specifically, the pair engagement flanges 322 a, 322 b extendlaterally from the pair of side walls 326 a, 326 b, respectively, andare disposed within the pair of internal grooves 314 a, 314 b ofcartridge housing 310 to prevent axial movement of clip carrier 320relative to cartridge housing 310.

As illustrated in FIGS. 6B and 6C, carrier lock 380 includes a body 382having a central arm 384 a, a pair of side arms 384 b, 384 c disposed onopposing lateral sides of central arm 384 a and outwardly biasedtherefrom, and a pair of legs 386 a, 386 b folded below and under aproximal end portion of body 382. Each side arm 384 b, 384 c includes atang 388 a, 388 b, respectively, extending outwardly therefrom. Internalcavity 312 of cartridge housing 310 is configured to receive carrierlock 380 such that the pair of side arms 384 b, 384 c are slidablydisposed within internal grooves 314 a, 314 b, respectively, ofcartridge housing 310. Cartridge housing 310 includes a pair of slots318 a, 318 b extending through opposing internal walls 311 a, 311 b. Thepair of slots 318 a, 318 b are positioned and configured to receive thepair of tangs 388 a, 388 b extending outwardly from the pair of sidearms 384 b, 384 c, respectively, to releasably retain carrier lock 380within internal cavity 312 of cartridge housing 310.

Each of the pair of tangs 388 a, 388 b includes a proximal portion 389 athat is substantially parallel relative to a respective proximal portionof the pair of slots 318 a, 318 b and a distal portion 389 b that isangled relative to a respective distal portion of the pair of slots 318a, 318 b. It is contemplated that during proximal movement of carrierlock 380 relative to cartridge housing 310, the parallel relationshipbetween each of the proximal portions 389 a of the pair of tangs 388 a,388 b and the respective proximal portions of the pair of slots 318 a,318 b will result in an abutting engagement to prevent inadvertentrelease of the pair of tangs 388 a, 388 b of carrier lock 380 fromwithin the pair of slots 318 a, 318 b of internal cavity 312 ofcartridge housing 310. Further, it is contemplated that during distalmovement of carrier lock 380 relative to cartridge housing 310, theangled relationship between each of the distal portions 389 b of thepair of tangs 388 a, 388 b and the respective distal portions of thepair of slots 318 a, 318 b will result in a camming engagement to enablerelease of the pair of tangs 388 a, 388 b of carrier lock 380 fromwithin the pair of slots 318 a, 318 b of internal cavity 312 ofcartridge housing 310.

With continued reference to FIG. 6B, when clip carrier 320 is disposedwithin cartridge housing 310, as described above, carrier lock 380 isconfigured for positioning proximally adjacent a proximal end portion ofclip carrier 320 such that central arm 384 a of carrier lock 380 isdisposed in abutting relation therewith. In this position, since carrierlock 380 is slidably retained within internal cavity 312 via engagementbetween the pair of tangs 388 a, 388 b and the pair of slots 318 a, 318b, clip carrier 320 is inhibited from moving proximally beyond centralarm 384 a of carrier lock 380. In this manner, clip carrier 320 isretained within internal cavity 312 of cartridge housing 310.

With additional reference to FIG. 6C, the pair of legs 386 a, 386 b ofcarrier lock 380 is folded below and under the proximal end portion ofbody 382 to define an angle “α” therebetween. In embodiments, angle “α”is less than 90 degrees. This effectively forms a four-bar linkagemechanism providing for easier cleaning and sterilization, all in a morerobust design having fewer parts. When cartridge assembly 300 isdisposed within shaft assembly 200, as will be detailed below, the pairof legs 386 a, 386 b of carrier lock 380 is configured to be supportedby a base 243 a of a distal drive bar 242 of shaft assembly 200.

With additional reference to FIGS. 7-9, clip carrier 320 furtherincludes a resilient central tang 328 extending upwardly from floor 322towards a distal end portion of clip carrier 320. Resilient central tang328 is configured to engage a backspan of a distal-most surgical clip“C1” of the stack of surgical clips “C” to retain the stack of surgicalclips “C” within clip carrier 320. Clip carrier 320 further includes aleg 329 depending from an underside of floor 322 adjacent a proximal endportion thereof.

With reference to FIGS. 3 and 8, clip follower 330 of clip cartridgeassembly 300 includes a distal sled 332 slidably disposed within clipcarrier 320 proximally of the stack of surgical clips “C.” Distal sled332 of clip follower 330, more specifically, is configured forpositioning proximally adjacent a proximal-most clip “C2” of the stackof surgical clips “C” in abutting relation therewith. Distal sled 332further defines a pair of slots 333 therethrough, as detailed below.Clip follower 330 further includes an elongated rod 334 extendingproximally from distal sled 332. Elongated rod 334 defines a fixeddistal end engaged to distal sled 332 and a free proximal end that isslidably disposed within a lumen 355 defined within base portion 354 ofslider 350. First biasing member 360 is disposed about elongated rod 334of clip follower 330 between distal sled 332 and base portion 354 ofslider 350 so as to bias distal sled 332 distally into and against theproximal-most clip “C2” of the stack of surgical clips “C,” therebybiasing the stack of surgical clips “C” distally. In embodiments, firstbiasing member 360 may take the form of a coil spring, a constant forcespring, a power spring, or another suitable biasing element.

With reference to FIGS. 3, 5, and 8, distal pusher 340 of clip cartridgeassembly 300 is slidably disposed about an underside of clip carrier320, opposite clip follower 330. Distal pusher 340 includes a pair ofpusher flanges 342 at a distal end portion thereof that are configuredto urge the distal-most surgical clip “C1” of the stack of surgicalclips “C” distally over resilient central tang 328 of clip carrier 320and distally from clip cartridge assembly 300 into jaws 238 (FIG. 10).Distal pusher 340 further includes a proximal slot 344 definedtherethrough adjacent a proximal end portion thereof that is configuredto slidably receive leg 329 of clip carrier 320 to maintain distalpusher 340 and clip carrier 320 in alignment with one another whilepermitting distal pusher 340 to slide longitudinally relative to clipcarrier 320. Specifically, distal pusher 340 is permitted to slidelongitudinally relative to clip carrier 320 until a position where leg329 of clip carrier 320 abuts a proximal end portion or a distal endportion of proximal slot 344 of distal pusher 340.

Distal pusher 340 also includes a flange or tab 346 depending from anunderside thereof at an intermediate portion of distal pusher 340. Tab346 is configured to receive a distal end portion 374 of second biasingmember 370 such that the distal end portion 374 of second biasing member370 is fixed relative to distal pusher 340. With distal end portion 374of second biasing member 370 fixed relative to distal pusher 340, andwith proximal end portion 372 thereof fixed relative to cartridgehousing 310 (via slot 313 c of second bridge portion 313 b, as notedabove), second biasing member 370 serves to bias distal pusher 340proximally relative to cartridge housing 310 and, thus, clip carrier 320and the stack of surgical clips “C.”

Distal pusher 340 additionally includes a proximally-facing pushersurface 348 disposed at the proximal end portion thereof.Proximally-facing pusher surface 348 may be part of a proximal extension349 that is monolithically formed with distal pusher 340 and foldedbelow and under the proximal end portion thereof to defineproximally-facing pusher surface 348.

Referring to FIGS. 3, 7, and 8, slider 350 of clip cartridge assembly300 includes a base portion 354 and a cap portion 352 disposed on baseportion 354. Cap portion 352, as detailed above, is configured forslidable receipt within window 316 of cartridge housing 310 and isreleasably engagable therein in either a proximal position or a distalposition. In the distal position, base portion 354 of slider 350 doesnot extend proximally beyond the proximal end portion of cartridgehousing 310. In the proximal position, base portion 354 extendsproximally beyond the proximal end portion of cartridge housing 310. Asdetailed below, movement of slider 350 between the distal and proximalposition enables selective locking and unlocking of clip cartridgeassembly 300 within shaft assembly 200 (FIG. 1).

Base portion 354 of slider 350, as noted above, defines a lumen 355extending longitudinally therethrough. Lumen 355 is configured toslidably receive elongated rod 334 of clip follower 330, as shown inFIGS. 7 and 8. Cap portion 352 of slider 350 may define a textured, suchas, for example, grooved, upper surface 356 to facilitate gripping capportion 352 of slider 350 to slide slider 350 between the proximal anddistal positions.

Continuing with reference to FIG. 3, the stack of surgical clips “C,” asdetailed above, is supported within clip carrier 320 with the clipsthereof arranged in tip-to-tail orientation. Each of the surgical clipsof the stack of surgical clips “C” includes a pair of legsinterconnected by a backspan. In some embodiments, the stack of surgicalclips “C” includes a lockout clip “LC” (FIG. 21) positioned proximallyof the proximal-most clip “C2”. The lockout clip “LC” is formed as asolid disc and may be distinctively marked and/or colored. Providing thelockout clip “LC” in this manner enables the user to visually determineor at least estimate the number of surgical clips remaining by viewingthe position of the lockout clip “LC” through cartridge housing 310. Thelockout clip “LC,” if loaded into jaws 238 (FIG. 22), also serves as alockout, as detailed below.

Referring to FIGS. 10-14, shaft assembly 200 includes an outer tube 210,an inner sleeve or bushing 220, a jaw assembly 230, and an inner driveassembly 240. Outer tube 210 includes an open distal end portion 212, anopen proximal end portion 214, a lumen 216 extending between andcommunicating with the open distal and proximal end portions, 212, 214,respectively, and an elongated cut-out 218 defined through a side wallof outer tube 210 and communicating with lumen 216 therethrough. Outertube 210 further includes a jaws support member 211 extending distallyfrom open distal end portion 212. In embodiments, jaws support member211 extends distally from a lower portion of outer tube 210 and towardsan upper portion of outer tube 210 to define a support surface 211 a.Elongated cut-out 218 is spaced-apart from open distal end portion 212of outer tube 210 such that outer tube 210 defines a tubular distalsegment 219 a disposed distally of elongated cut-out 218. With briefreference to FIG. 21, in embodiments, tubular distal segment 219 a ofouter tube 210 may include indicia “I” configured to enable the user tovisually determine or at least estimate the number of surgical clipsremaining by viewing the position of the lockout clip “LC” throughcartridge housing 310. Elongated cut-out 218 is also spaced-apart fromopen proximal end portion 214 of outer tube 210 such that outer tubedefines a tubular proximal segment 219 b disposed proximally ofelongated cut-out 218. Tubular proximal segment 219 b includes anelongated recess or slot 219 c configured to engage handle assembly 100(FIG. 20) to selectively couple shaft assembly 200 and handle assembly100, as detailed below. In embodiments, tubular proximal segment 219 bmay include more than one slot 219 c.

With reference to FIGS. 13 and 14, inner bushing 220 is disposed withintubular proximal segment 219 b of outer tube 210. Inner bushing 220includes an open distal end 222, an open proximal end 224, a lumen 226extending between and communicating with the open distal and proximalends, 222, 224, respectively, and an elongated recess or slot 228defined through a side wall of inner bushing 220. In embodiments, innerbushing 220 may include more than one slot 228. When inner bushing 220is disposed within tubular proximal segment 219 b of outer tube 210, oneor more slot(s) 219 c of outer tube 210 and one or more slot(s) 228 ofinner bushing 220 are sized and aligningly configured to engage handleassembly 100 (FIG. 20) to selectively couple outer tube 210 and innerbushing 220 of shaft assembly 200, with handle assembly 100, as detailedbelow.

Referring to FIGS. 12 and 14, jaw assembly 230 includes a stationarybase 232 and a jaws component 236. Stationary base 232 is affixed withinouter tube 210 to an interior surface thereof, via welding or othersuitable methods. Stationary base 232 includes a proximal base portion233, a central block 234, and a distal base portion 235. Jaws component236 includes a proximal hub 237 a, a bifurcated neck 237 b, and a pairof jaws 238, one of which is attached to the free distal end of each ofthe bifurcated portions of bifurcated neck 237 b. Proximal hub 237 a ofjaws component 236 defines a slot 237 c configured to receive centralblock 234 of stationary base 232 to engage and fixedly maintain jawscomponent 236 within outer tube 210. With jaws component 236 engagedabout stationary base 232 in this manner, jaws 238 extend distally fromopen distal end 212 of outer tube 210.

Jaws 238 of jaw assembly 230 are biased apart from one another viabifurcated neck 237 b. Jaws 238 define outwardly-facing cam surfaces 239a and inwardly-facing channels 239 b. A distal drive bar 242 of innerdrive assembly 240 is configured to engage cam surfaces 239 a of jaws238 and urge jaws 238 towards one another, as detailed below.Inwardly-facing channels 239 b of jaws 238 are configured to receive thelegs of a surgical clip from the stack of surgical clips “C” therein toretain the surgical clip within the jaws 238 during formation thereof,as also detailed below.

Continuing with reference to FIGS. 10-14, inner drive assembly 240 ofshaft assembly 200 includes a distal drive bar 242 and a proximal driveplunger 244. Distal drive bar 242 includes a base 243 a and a pair ofside walls 243 b extending longitudinally along opposing sides of base243 a so as to define an inner channel 243 c extending longitudinallyalong distal drive bar 242.

Distal drive bar 242 of inner drive assembly 240 further includes aboxed distal end portion 243 d and a slot 243 e defined through base 243a towards the boxed distal end portion 243 d thereof. Distal drive bar242 is slidably disposed within lumen 216 of outer tube 210. Slot 243 eof distal drive bar 242 is configured to slidably receive stationarybase 232 of jaw assembly 230 therethrough to enable distal drive bar 242to slide within outer tube 210 and about stationary base 232. Boxeddistal end portion 243 d of distal drive bar 242 is configured forpositioning about bifurcated neck 237 b of jaw assembly 230. Upon distaladvancement of distal drive bar 242, as detailed below, boxed distal endportion 243 d of distal drive bar 242 is advanced distally about jawscomponent 236 to cam about cam surfaces 239 a of jaws 238 to therebyurge jaws 238 towards one another.

Proximal drive plunger 244 of inner drive assembly 240 is slidablydisposed within lumen 226 of inner bushing 220, when inner bushing 220is disposed within tubular proximal segment 219 b of outer tube 210.Proximal drive plunger 244 includes a hub 245 having an open distal endportion 246 a, an open proximal end portion 246 b, and a hub lumen 247extending between and communicating with the open distal and proximalend portions, 246 a, 246 b, respectively. Open distal end portion 246 aof hub 245 is engaged with a proximal end portion of inner channel 243 cof distal drive bar 242 such that hub lumen 247 is in communication withinner channel 243 c of distal drive bar 242. Hub 245 includes an innerhub wall 248 a adjacent open distal end portion 246 a and an outer hubwall 248 b adjacent open proximal end portion 246 b. Hub lumen 247extends between and is in communication with inner hub wall 248 a andouter hub wall 248 b. Hub 245 further includes a threaded opening orbore 249 configured to receive a lock screw 250 (FIG. 20) to releasablyfix distal drive bar 242 and an outer drive tube 142 of handle assembly100, as detailed below.

Jaws component 236 and inner drive assembly 240 are removable from outertube 210 to facilitate reprocessing of the various components thereoffor reuse. In order to insert jaws component 236 and inner driveassembly 240 into operable engagement with outer tube 210 and oneanother, jaws component 236, led by proximal hub 237 a thereof, isinserted proximally through open distal end 212 of outer tube 210 untilslot 237 c of jaws component 236 is aligned above central block 234 ofstationary base 232. Inner bushing 220, led by open distal end portion246 a, is inserted distally through open proximal end 214 of outer tube210 and slid distally about tubular proximal segment 219 b of outer tube210 until inner bushing 220 is disposed within lumen 216 such that, slot219 c of outer tube 210 and slot 228 of inner bushing 220 are axiallyaligned. Inner drive assembly 240, led by boxed distal end portion 243 dof distal drive bar 242, is inserted distally through open proximal end214 of outer tube 210 and open proximal end 224 of inner bushing 220,and slid distally about jaws component 236 until boxed distal endportion 243 d of distal drive bar 242 is disposed about bifurcated neck237 b of jaws component 236, such that proximal hub 237 a of jawscomponent 236 is disposed above slot 243 e of base 243 a of distal drivebar 242, and such that hub 245 of proximal drive plunger 244 is disposedwithin lumen 226 of inner bushing 220.

Once inner drive assembly 240 and jaws component 236 have beenpositioned as detailed above, proximal hub 237 a of jaws component 236may be engaged with stationary base 232 through slot 243 e of base 243 aof distal drive bar 242. More specifically, proximal hub 237 a of jawscomponent 236 is urged towards central block 234 of stationary base 232such that central block 234 is received within slot 237 c of jawscomponent 236. With jaws component 236 engaged with stationary base 232in this manner, stationary base 232 extends at least partially throughslot 243 e of base 243 a of distal drive bar 242 and boxed distal endportion 243 d of distal drive bar 242 is disposed about bifurcated neck237 b of jaws component 236. Thus, outer tube 210, inner bushing 220,jaws component 236, and inner drive assembly 240 are operably engagedwith one another. When shaft assembly 200 is assembled as illustrated inFIG. 13, lumen 216 of outer tube 210, lumen 226 of inner bushing 220,and hub lumen 247 of distal drive bar 242 are in communication with oneanother to slidably receive handle assembly 100, as detailed below.Disengagement and removal of jaws component 236, inner bushing 220, andinner drive assembly 240 from outer tube 210 are effected in theopposite manner of the above-detailed insertion and engagement.

Referring to FIGS. 1, 2, 15-17, and 20, handle assembly 100 includes ahousing 110, a pair of handles 130, an inner actuation assembly 140, anda linkage assembly 160. Housing 110 includes an upper housing portion112 and lower housing portion 114 secured to one another by a pluralityof screws 116, although other suitable engagements are alsocontemplated. As illustrated in FIG. 16, each housing portion 112, 114further includes a pair of pivot recesses 117 defined by internalfeatures, such as, for example, internal arcuate walls 119. Each pivotrecess 117 has a substantially “V” shaped configuration with a tapereddistal end portion 117 a and an open proximal end portion 117 b. Eachpivot recess 117 includes a width “W1” adjacent open proximal endportion 117 b which gradually decreases towards tapered distal endportion 117 a thereof. Pivot recesses 117 are configured to enablemovement of the pair of handles 130, respectively, about housing 110between a spaced-apart position (FIG. 1) and an approximated position(FIG. 2). Respective widths “W1” of each pivot recess 117 and a width“W2” of each handle 130 is configured to cooperate, at least in part, tolimit movement of the pair of handles 130 beyond a predetermined maximumspaced-apart position and beyond a predetermined maximum approximatedposition.

With reference to FIGS. 15-17 and 20, housing 110 includes an opendistal end portion 126 a and an open proximal end portion 126 b. Opendistal and proximal end portions 126 a, 126 b are formed fromcooperating portions of upper housing portion 112 and lower housingportion 114, and define a central passageway 118 therebetween (FIG. 20).Central passageway 118 is configured to receive a proximal end portionof shaft assembly 200 therethrough to releasably engage shaft assembly200 with handle assembly 100, as detailed below.

At least one of the upper and lower housing portions 112, 114 includes atab or protrusion 128 (FIGS. 17 and 20) adjacent open distal end portion126 a and extending radially inwardly into central passageway 118.Protrusion 128 is configured to releasably engage slots 219 c, 228(FIGS. 17 and 20) of tubular proximal segment 219 b and inner bushing220, respectively, such that outer tube 210 and inner bushing 220 arereleasably fixed to housing 110, to releasably engage shaft assembly 200with handle assembly 100, as detailed below.

At least one of the upper and lower housing portions 112, 114 includes alip 127 extending proximally from open proximal end portion 126 b. Lip127 includes an internal feature, such as, for example, a slot or groove129. Grooves 129 of each respective lip 127 of upper and lower housingportions 112, 114 cooperate to receive and retain a handle springassembly 144 of handle assembly 100, as will be detailed below.

Handles 130 of handle assembly 100 are pivotably coupled to housing 110and extend outwardly from opposing sides thereof. More specifically,each handle 130 includes a pivot bore 132 at the distal end portionthereof and a finger loop 134 at the proximal end portion thereof. Eachof the distal end portions of handles 130 are disposed within therespective pivot recess 117 of housing 110 such that the plurality ofscrews 116 extend through at least one of the upper and lower housingportions 112, 114 and through pivot bores 132 to enable pivoting ofhandles 130 relative to housing 110 between a spaced-apart position andan approximated position. Finger loops 134 facilitate manipulation ofhandles 130 to pivot handles 130 between the spaced-apart andapproximated positions.

Referring to FIGS. 15, 17, and 20, inner actuation assembly 140 includesa proximal drive member such as, for example, outer drive tube 142, ahandle spring assembly 144, and a proximal pusher bar 148. At least aportion of outer drive tube 142 is slidably disposed within housing 110.Outer drive tube 142 includes a body portion 143 a, a neck portion 143 bextending distally from a distal end portion of body portion 143 a, anda substantially flat mounting portion 143 c extending proximally from aproximal end portion of body portion 143 a. Body portion 143 a includesan outer diameter “D1” that is greater than an outer diameter “D2” ofneck portion 143 b. Body portion 143 a includes a shoulder 143 d at thedistal end portion thereof, defined by the transition from outerdiameter “D1” of body portion 143 a to outer diameter “D2” of neckportion 143 b. Neck portion 143 b includes a threaded opening or bore143 e configured to receive lock screw 250 via bore 249 of hub 245 tocouple distal drive bar 242 and outer drive tube 142 (FIG. 20). Outerdrive tube 142 further includes a lumen 141 (FIG. 20) extendinglongitudinally therethrough in communication with neck portion 143 b andmounting portion 143 c. In operation, proximal pusher bar 148 extendsthrough mounting portion 143 c of outer drive tube 142, through lumen141 of outer drive tube 142 in slidable relation relative thereto, anddistally from neck portion 143 b of outer drive tube 142, as detailedbelow.

With continued reference to FIGS. 15, 17, and 20, handle spring assembly144 includes a transverse body portion 145 and a pair of spring arms147. Transverse body portion 145 includes an upper portion 145 a and alower portion 145 b. Upper and lower portions 145 a, 145 b of transversebody portion 145 are configured to be received within respective grooves129 of upper and lower housing portions 112, 114 of housing 110 ofhandle assembly 100 such that transverse body portion 145 of handlespring assembly 144 is fixed between upper and lower housing portions112, 114 of housing 110. In operation, transverse body portion 145 isdisposed proximally adjacent open proximal end portion 214 of outer tube210 of shaft assembly 200. In embodiments, transverse body portion 145is disposed proximally abutting open proximal end portion 214 of outertube 210 of shaft assembly 200. Transverse body portion 145 includes aslot or bore 145 c extending therethrough and configured to be incommunication with lumen 216 of outer tube 210 of shaft assembly 200. Inoperation, outer drive tube 142 extends through bore 145 c of transversebody portion 145 in slidable relation relative thereto, and engagesshaft assembly 200.

Spring arms 147 of handle spring assembly 144 each include a fixeddistal end portion 147 a coupled to opposing lateral sides of transversebody portion 145 and a free proximal end portion 147 b. Spring arms 147extend outwardly from opposing lateral sides of transverse body portion145 and are gradually spaced apart. Spring arms 147 are outwardly biasedapart and are configured to engage respective handles 130 to urgehandles 130 towards the spaced-apart position. Specifically, spring arms147 each include an inner surface 147 c, and at least a portion of theinner surface 147 c is configured to maintain contact with, and sliderelative to handles 130 when handles 130 are manipulated between thespaced-apart and approximated positions.

Referring to FIG. 15, handle assembly 100 further includes a linkageassembly 160 configured to pivotably couple handles 130 to inneractuation assembly 140. Linkage assembly 160 includes a first link arm162, a second link arm 164, a third link arm 166, and a fourth link arm168. Each of the first and second link arms 162, 164 are pivotablycoupled at a first end portion thereof to an intermediate portion of oneof the handles 130 via a first pivot boss 161 a and each of the thirdand fourth link arms 166, 168 are pivotably coupled at a first endportion thereof to an intermediate portion of the other of the handles130 via a second pivot boss 161 b. Each of the first and fourth linkarms 162, 168 are internally pivotably coupled at mounting portion 143 cof outer drive tube 142 adjacent the proximal end portion of body 143 avia a third pivot boss 161 c. Each of the second and third link arms164, 166 are internally pivotably coupled at a second end portionthereof to a pusher mount 148 a adjacent the proximal end portion ofproximal pusher bar 148 via a fourth pivot boss 161 d. As illustrated inFIG. 17, third pivot boss 161 c includes a bore 163 extendingtherethrough and configured to be in communication with lumen 141 ofouter drive tube 142. In operation, proximal pusher bar 148 extendsthrough bore 163 of third pivot boss 161 c, in slidable relationthereto, and distally through lumen 141 of outer drive tube 142.

In embodiments, first, second, third, and fourth link arms 162, 164,166, and 168 are disposed such that each of the intermediate portions ofhandles 130, mounting portion 143 c of outer drive tube 142, and pushermount 148 a of proximal pusher bar 148 are sandwiched between respectiveportions of first, second, third, and fourth link arms 162, 164, 166,and 168 as described above. In embodiments, each of the first, second,third, and fourth pivot bosses 161 a, 161 b, 161 c, and 161 d includes alocking element 165 configured to inhibit axial movement and inadvertentrelease of the first, second, third, and fourth pivot bosses 161 a, 161b, 161 c, and 161 d when linkage assembly 160 is assembled as describedabove.

Referring to FIGS. 15 and 17, in operation, with handles 130 disposed inthe spaced-apart position relative to housing 110, outer drive tube 142is disposed in a proximal-most position, while proximal pusher bar 148is disposed in a distal-most position. As handles 130 are pivotedtowards housing 110, towards the approximated position, first and fourthlink arms 162, 168 urge outer drive tube 142 distally, and second andthird link arms 164, 166 pull proximal pusher bar 148 proximally. It iscontemplated that as handles 130 are pivoted towards the approximatedposition, linkage assembly 160 is configured to move outer drive tube142 concurrently with proximal pusher bar 148. With handles 130 disposedin the approximated position relative to housing 110, outer drive tube142 is disposed in a distal-most position, while proximal pusher bar 148is disposed in a proximal-most position.

During the above-noted pivoting of handles 130 towards the approximatedposition, spring arms 147 of handle spring assembly 144 engage thehandles 130 such that handles 130 are moved through an actuation strokeagainst the outward bias of spring arms 147. As noted earlier, thepredetermined maximum approximated position is determined, at least inpart, by the cooperation between width “W1” of each pivot recess 117 ofhousing 110 and width “W2” of each handle 130, respectively (FIG. 16).

Upon release or return of handles 130 towards the spaced-apart positionrelative to housing 110, handles 130 move first and fourth link arms162, 168 to pull outer drive tube 142 proximally, and move second andthird link arms 164, 166 to urge proximal pusher bar 148 distally. It iscontemplated that as handles 130 are pivoted towards the spaced-apartposition, linkage assembly 160 is configured to move outer drive tube142 concurrently with proximal pusher bar 148. With handles 130 disposedin the spaced-apart position relative to housing 110, outer drive tube142 is disposed in the proximal-most position, while proximal pusher bar148 is disposed in the distal-most position.

During the above-noted return of handles 130 towards the spaced-apartposition, spring arms 147 of handle spring assembly 144 engage thehandles 130 such that handles 130 are moved through a return stroke withthe outward bias of spring arms 147. Accordingly, the bias of handlespring assembly 144 is configured to pull outer drive tube 142proximally and urge proximal pusher bar 148 distally. As noted earlier,the predetermined maximum spaced-apart position is determined, at leastin part, by the cooperation between width “W1” of each pivot recess 117of housing 110 and width “W2” of each handle 130, respectively (FIG.16).

Turning now to FIGS. 1 and 17-20, in order to assemble surgical clipapplier 10 for use, handle assembly 100, shaft assembly 200, and clipcartridge assembly 300, if not preassembled, are individually assembled,as detailed above. Thereafter, shaft assembly 200 is engaged with handleassembly 100, as detailed below.

With reference to FIGS. 17 and 20, in order to engage shaft assembly 200with handle assembly 100, the proximal end portion of shaft assembly 200is inserted proximally into open distal end portion 126 a of housing110. More specifically, shaft assembly 200 is moved proximally relativeto handle assembly 100 such that tubular proximal segment 219 b of shaftassembly 200 is inserted proximally into central passageway 118 untilprotrusion 128 is received within slots 219 c, 228 of tubular proximalsegment 219 b and inner bushing 220, respectively, to thereby releasablyengage shaft assembly 200 with handle assembly 100. In embodiments, ifhousing 110 is preassembled, the plurality of screws 116 may be removedor loosened to space apart upper housing portion 112 and lower housingportion 114 such that slots 219 c, 228 of tubular proximal segment 219 band inner bushing 220, respectively, may be aligned with protrusion 128.Once protrusion 128 is received within slots 219 c, 228 of tubularproximal segment 219 b and inner bushing 220, respectively, upperhousing portion 112 and lower housing portion 114 may be secured to oneanother by the plurality of screws 116.

During the above-noted insertion of the proximal end portion of shaftassembly 200 into open distal end portion 126 a of housing 110, outerdrive tube 142 and proximal pusher bar 148 disposed within lumen 141 ofouter drive tube 142, are received within and extends through hub lumen247 of hub 245 of proximal drive plunger 244 of inner drive assembly 240of shaft assembly 200. When shaft assembly 200 engages with handleassembly 100 as detailed above, neck portion 143 b of outer drive tube142 is positioned proximally adjacent inner hub wall 248 a of hub 245 ofproximal drive plunger 244 and shoulder 143 d of outer drive tube 142 ispositioned proximally adjacent outer hub wall 248 b of hub 245 ofproximal drive plunger 244. With neck portion 143 b of outer drive tube142 disposed within hub 245 of distal drive bar 242, lock screw 250 isdisposed within bore 249 of hub 245 and bore 143 e of neck portion 143 bto releasably fix distal drive bar 242 and outer drive tube 142.

Further, when shaft assembly 200 engages with handle assembly 100 asdetailed above, proximal pusher bar 148 extends through lumen 141 ofbody 143 a and neck portion 143 b of outer drive tube 142 in slidablerelation relative thereto, distally from open distal end portion 246 aof hub 245. Once shaft assembly 200 is engaged with handle assembly 100,clip cartridge assembly 300 may be engaged within shaft assembly 200, asdetailed below.

Referring to FIGS. 18 and 19, to engage clip cartridge assembly 300within shaft assembly 200, slider 350 of clip cartridge assembly 300, ifnot already in the distal position, is moved to the distal position,wherein base portion 354 of slider 350 does not extend proximally beyondthe proximal end portion of cartridge housing 310 and whereinmore-proximally positioned recess 353 a of cap portion 352 of slider 350is engaged within protrusion 317 of cartridge housing 310 to retainslider 350 in the distal position.

With reference to FIG. 18, with slider 350 in the distal position, clipcartridge assembly 300 is inserted through elongated cut-out 218 ofouter tube 210 of shaft assembly 200 and distally relative to outer tube210 such that the distal end portion of cartridge housing 310 ducksunder tubular distal segment 219 a of outer tube 210 and extends throughthe portion of lumen 216 defined by tubular distal segment 219 a ofouter tube 210. Following the positioning of the distal end portion ofcartridge housing 310 in this manner, the remainder of clip cartridgeassembly 300 is inserted through elongated cut-out 218 to be seatedwithin lumen 216 of outer tube 210.

Referring to FIGS. 7, 8, and 19, once clip cartridge assembly 300 isfully seated within lumen 216 of outer tube 210 with the distal endportion of cartridge housing 310 extending through tubular distalsegment 219 a of outer tube 210, slider 350 is urged proximally suchthat protrusion 317 of cartridge housing 310 is dislodged frommore-proximally positioned recess 353 a of cap portion 352 of slider350, slider 350 is slid proximally through window 316, and protrusion317 is engaged within more-distally positioned recess 353 b of capportion 352 of slider 350 to retain slider 350 in the proximal position.

In the proximal position of slider 350, base portion 354 of slider 350extends proximally beyond the proximal end portion of cartridge housing310 and into tubular proximal segment 219 b of outer tube 210. Thus,with base portion 354 of slider 350 extending into tubular proximalsegment 219 b of outer tube 210 and the distal end portion of cartridgehousing 310 extending through tubular distal segment 219 a of outer tube210, clip cartridge assembly 300 is locked in engagement within shaftassembly 200. Disengagement and removal of clip cartridge assembly 300is effected in the opposite manner as the insertion and engagementdetailed above.

With additional reference to FIG. 2, handles 130 of handle assembly 100are moved to and maintained in the approximated position during theabove-noted insertion of clip cartridge assembly 300 into shaft assembly200, although handles 130 need not be maintained in the approximatedposition during movement of slider 350 to lock clip cartridge assembly300 within shaft assembly 200.

By maintaining handles 130 of handle assembly 100 in the approximatedposition during insertion of clip cartridge assembly 300 into shaftassembly 200, proximal pusher bar 148 is disposed in a proximal-mostposition such that, proximal pusher bar 148 does not interfere with theinsertion of clip cartridge assembly 300 into shaft assembly 200.Rather, proximal pusher bar 148, in the proximal-most position thereof,is maintained proximally of proximally-facing pusher surface 348 ofdistal pusher 340 of clip cartridge assembly 300.

Referring to FIGS. 1, 3, 7-9, 13, and 20, once clip cartridge assembly300 is disposed within shaft assembly 200, handles 130 may be releasedor returned towards the spaced-apart position (FIG. 1) such thatproximal pusher bar 148 is moved distally through lumen 141 of outerdrive tube 142 and towards the distal-most position of proximal pusherbar 148. As proximal pusher bar 148 is moved distally, a distal endportion of proximal pusher bar 148 is urged into proximally-facingpusher surface 348 of distal pusher 340 to thereby urge distal pusher340 distally. As distal pusher 340 is moved distally, pusher flanges 342thereof engage a backspan of a distal-most surgical clip “C1” of thestack of surgical clips “C” and urge the distal-most surgical clip “C1”distally over resilient central tang 328 of clip carrier 320 anddistally from clip cartridge assembly 300 into inwardly-facing channels239 b of jaws 238. Thus, surgical clip applier 10 is loaded with asurgical clip within jaws 238 and ready for use (FIG. 9). As thedistal-most clip of the stack of surgical clips “C” is loaded into jaws238, sled 332 of clip follower 330, under the bias of first biasingmember 360, urges the remaining clips, in the stack of surgical clips“C”, distally such that each clip takes the position previously occupiedby its distally-adjacent clip.

In use, with general reference to FIGS. 1, 2, 13, and 20-22, surgicalclip applier 10 is manipulated such that a vessel (or other tissue), tobe ligated, is disposed between jaws 238. Once this position has beenachieved, handles 130 are moved from the spaced-apart position (FIG. 1)towards the approximated position (FIG. 2). As detailed above, ashandles 130 are moved towards the approximated position against the biasof handle spring assembly 144, outer drive tube 142 is urged distally.As outer drive tube 142 is urged distally, proximal drive plunger 244,which is coupled to outer drive tube 142 via lock screw 250, is in turnmoved distally to thereby urge distal drive bar 242 distally. As distaldrive bar 242 is advanced distally, boxed distal end portion 243 d ofdistal drive bar 242 is advanced distally to cam about cam surfaces 239a of jaws 238, thereby urging jaws 238 towards one another to form thesurgical clip loaded therein about the vessel (or other tissue).

Once the surgical clip is formed about the vessel (or other tissue),handles 130 may be released or returned towards the spaced-apartposition such that the next distal-most surgical clip “C1” of the stackof surgical clips “C” is loaded into jaws 238 for subsequent firing. Theabove-detailed use of surgical clip applier 10 may be repeated to fire aplurality of surgical clips from the stack of surgical clips “C” untilonly the lockout clip “LC” remains.

Referring to FIGS. 1, 21, and 22, once the proximal-most clip “C2”, thesurgical clip disposed distally adjacent the lockout clip “LC,” has beenfired and handles 130 are released or returned towards the spaced-apartposition, distal pusher 340 is moved distally such that pusher flanges342 thereof engage a proximally-facing edge of the lockout clip “LC” andurges the lockout clip “LC” distally from clip cartridge assembly 300into inwardly-facing channels 239 b of jaws 238. Since the lockout clip“LC” is formed as a solid disc, jaws 238 are inhibited from being movedtowards one another when the lockout clip “LC” is disposed therebetween.Thus, actuation of handles 130 is inhibited. Further, with no clipsremaining in clip cartridge assembly 300, sled 332 of clip follower 330is moved to the distal end portion of clip carrier 320 under the bias offirst biasing member 360. As a result of this configuration, as pusherflanges 342 are moved proximally in response to the release or return ofhandles 130 towards the spaced-apart position, pusher flanges 342 areengaged within slots 333 of sled 332 of clip follower 330 to furtherinhibit subsequent actuation of handles 130. Thus, clip-less firing ofsurgical clip applier 10 is inhibited.

The present disclosure contemplates that surgical clip applier 10 becapable of loading different surgical clip cartridge assemblies 300within shaft assembly 200. Specifically, surgical clip applier 10 may beloaded with a clip cartridge assembly 300 having a stack of surgicalclips “C” of a particular size and/or configuration. For example,depending upon a particular purpose, a first clip cartridge assembly 300having a stack of surgical clips “C” of a first size or a second clipcartridge assembly 300 having a stack of surgical clips “C” of a secondsize different than the first size may be loaded into shaft assembly200. Additionally, during a surgical procedure, if the need arises touse a different size and/or configuration of surgical clip, the user mayremove the clip cartridge assembly 300 being used in favor of adifferent clip cartridge assembly 300.

The present disclosure further contemplates a surgical kit including onehandle assembly 100, one shaft assembly 200, and one or more clipcartridge assemblies 300 (similar or different from one another). Thekit may also include instructions for the assembly of surgical clipapplier 10, the use of surgical clip applier 10, and/or the reprocessingof reusable components of surgical clip applier 10 following use. Apackage, container, or box may also be provided.

Surgical instruments such as the clip applier(s), or components thereof,described herein may also be configured to work with robotic surgicalsystems and what is commonly referred to as “Telesurgery.” Such systemsemploy various robotic elements to assist the surgeon and allow remoteoperation (or partial remote operation) of surgical instrumentation.Various robotic arms, gears, cams, pulleys, electric and mechanicalmotors, etc. may be employed for this purpose and may be designed with arobotic surgical system to assist the surgeon during the course of anoperation or treatment. Such robotic systems may include remotelysteerable systems, automatically flexible surgical systems, remotelyflexible surgical systems, remotely articulating surgical systems,wireless surgical systems, modular or selectively configurable remotelyoperated surgical systems, etc.

The robotic surgical systems may be employed with one or more consolesthat are next to the operating theater or located in a remote location.In this instance, one team of surgeons or nurses may prep the patientfor surgery and configure the robotic surgical system with one or moreof the instruments disclosed herein while another surgeon (or group ofsurgeons) remotely control the instruments via the robotic surgicalsystem. As can be appreciated, a highly skilled surgeon may performmultiple operations in multiple locations without leaving his/her remoteconsole which can be both economically advantageous and a benefit to thepatient or a series of patients.

The robotic arms of the surgical system are typically coupled to a pairof master handles by a controller. The handles can be moved by thesurgeon to produce a corresponding movement of the working ends of anytype of surgical instrument (e.g., end effectors, graspers, knifes,scissors, etc.) which may complement the use of one or more of theembodiments described herein. The movement of the master handles may bescaled so that the working ends have a corresponding movement that isdifferent, smaller or larger, than the movement performed by theoperating hands of the surgeon. The scale factor or gearing ratio may beadjustable so that the operator can control the resolution of theworking ends of the surgical instrument(s).

The master handles may include various sensors to provide feedback tothe surgeon relating to various tissue parameters or conditions, e.g.,tissue resistance due to manipulation, cutting or otherwise treating,pressure by the instrument onto the tissue, tissue temperature, tissueimpedance, etc. As can be appreciated, such sensors provide the surgeonwith enhanced tactile feedback simulating actual operating conditions.The master handles may also include a variety of different actuators fordelicate tissue manipulation or treatment further enhancing thesurgeon's ability to mimic actual operating conditions.

Referring to FIG. 23, a medical work station is shown generally as workstation 1000 and generally may include a plurality of robot arms 1002,1003; a control device 1004; and an operating console 1005 coupled withcontrol device 1004. Operating console 1005 may include a display device1006, which may be set up in particular to display three-dimensionalimages; and manual input devices 1007, 1008, by means of which a person(not shown), for example a surgeon, may be able to telemanipulate robotarms 1002, 1003 in a first operating mode.

Each of the robot arms 1002, 1003 may include a plurality of members,which are connected through joints, and an attaching device 1009, 1011,to which may be attached, for example, a surgical tool “ST” supportingan end effector 1100, in accordance with any one of several embodimentsdisclosed herein, as will be described in greater detail below.

Robot arms 1002, 1003 may be driven by electric drives (not shown) thatare connected to control device 1004. Control device 1004 (e.g., acomputer) may be set up to activate the drives, in particular by meansof a computer program, in such a way that robot arms 1002, 1003, theirattaching devices 1009, 1011 and thus the surgical tool (including endeffector 1100) execute a desired movement according to a movementdefined by means of manual input devices 1007, 1008. Control device 1004may also be set up in such a way that it regulates the movement of robotarms 1002, 1003 and/or of the drives.

Medical work station 1000 may be configured for use on a patient 1013lying on a patient table 1012 to be treated in a minimally invasivemanner by means of end effector 1100. Medical work station 1000 may alsoinclude more than two robot arms 1002, 1003, the additional robot armslikewise being connected to control device 1004 and beingtelemanipulatable by means of operating console 1005. A medicalinstrument or surgical tool (including an end effector 1100) may also beattached to the additional robot arm. Medical work station 1000 mayinclude a database 1014, in particular coupled to with control device1004, in which are stored, for example, pre-operative data frompatient/living being 1013 and/or anatomical atlases.

Reference is made herein to U.S. Pat. No. 8,828,023, the entire contentof which is incorporated herein by reference, for a more detaileddiscussion of the construction and operation of an exemplary roboticsurgical system.

It should be understood that the foregoing description is onlyillustrative of the present disclosure. Various alternatives andmodifications can be devised by those skilled in the art withoutdeparting from the disclosure. Accordingly, the present disclosure isintended to embrace all such alternatives, modifications and variances.The embodiments described with reference to the attached drawing figuresare presented only to demonstrate certain examples of the disclosure.Other elements, steps, methods and techniques that are insubstantiallydifferent from those described above and/or in the appended claims arealso intended to be within the scope of the disclosure.

What is claimed is:
 1. A reposable surgical clip applier, comprising: ahandle assembly, including: a housing; at least one handle extendingfrom the housing and movable relative to the housing between aspaced-apart position and an approximated position; and an inneractuation assembly extending from the housing and operably coupled tothe at least one handle, the inner actuation assembly including: aproximal drive member movable through the housing; a proximal pusher barmovable through the proximal drive member; and a handle spring assemblyhaving at least one spring arm engaging the at least one handle to biasthe at least one handle towards the spaced-apart position, whereinmovement of the at least one handle relative to the housing isconfigured to move the proximal drive member and the proximal pusher barin relative opposing directions; a shaft assembly releasably engagablewith the handle assembly, the shaft assembly including: an outer tube; ajaw assembly supported at a distal end portion of the outer tube; and aninner drive assembly slidably disposed within the outer tube andoperably coupled to the jaw assembly such that distal movement of theinner drive assembly through the outer tube actuates the jaw assembly;and a clip cartridge assembly releasably engagable within the shaftassembly, the clip cartridge assembly retaining a stack of surgicalclips therein and including: a distal pusher operably coupled to adistal-most surgical clip of the stack of surgical clips such thatdistal movement of the distal pusher loads the distal-most surgical clipinto the jaw assembly when the clip cartridge assembly is releasablyengaged within the shaft assembly; a biasing member configured to biasthe distal pusher proximally; and a cartridge housing having a supportbase configured to support at least a portion of the distal pusher, thesupport base including a distal bridge portion and a proximal bridgeportion, wherein the biasing member of the cartridge assembly isoperably coupled to the distal pusher and to the proximal bridge portionto bias the distal pusher proximally, wherein, when the shaft assemblyis releasably engaged with the handle assembly and the clip cartridgeassembly is releasably engaged within the shaft assembly: the proximaldrive member is positioned proximally adjacent the inner drive assemblysuch that movement of the at least one handle towards the approximatedposition actuates the jaw assembly, and the proximal pusher bar ispositioned proximally adjacent the distal pusher such that movement ofthe at least one handle towards the spaced-apart position loads thedistal-most surgical clip into the jaw assembly.
 2. The reposablesurgical clip applier according to claim 1, wherein the handle springassembly includes a transverse body portion releasably retained within aproximal end portion of the housing, the transverse body portiondefining a bore configured to be in communication with the outer tube ofthe shaft assembly such that, the proximal drive member is movablethrough the bore of the handle spring assembly to engage the inner driveassembly of the shaft assembly upon movement of the at least one handle.3. The reposable surgical clip applier according to claim 2, wherein theat least one spring arm of the handle spring assembly extends outwardlyfrom the transverse body portion and includes a free proximal endportion, the free proximal end portion of the at least one spring armslidable along the at least handle upon movement of the at least onehandle.
 4. The reposable surgical clip applier according to claim 1,wherein the housing includes at least one internal feature defining apivot recess configured to movably receive a distal end portion of theat least one handle, the pivot recess and the at least one handle beingsized and configured to cooperate to limit movement of the at least onehandle beyond a predetermined approximated position and beyond apredetermined spaced-apart position.
 5. The reposable surgical clipapplier according to claim 1, wherein movement of the at least onehandle towards the approximated position moves the proximal drive memberdistally about the proximal pusher bar and moves the proximal pusher barproximally about and through the proximal drive member, and whereinmovement of the at least one handle towards the spaced-apart positionmoves the proximal drive member proximally about the proximal pusher barand moves the proximal pusher bar distally about and through theproximal drive member.
 6. The reposable surgical clip applier accordingto claim 1, wherein the housing of the handle assembly includes an opendistal end portion defining a central passageway and a protrusionextending inwardly into the central passageway, and wherein the shaftassembly includes a tubular proximal segment defining a slot configuredto receive the protrusion upon insertion of the tubular proximal segmentinto the open distal end portion to releasably engage the shaft assemblywith the handle assembly.
 7. The reposable surgical clip applieraccording to claim 6, wherein the shaft assembly further includes aninner bushing disposed between the tubular proximal segment and theinner drive assembly, the inner bushing including a slot configured tobe axially aligned with the slot of the tubular proximal segment whenthe inner bushing is disposed therein, such that, the protrusionextending inwardly from the housing is received within the slot of thetubular proximal segment and the slot of the inner bushing.
 8. Thereposable surgical clip applier according to claim 1, wherein the handleassembly includes a pair of handles pivotably coupled to the housing andextending from opposed sides thereof.
 9. The reposable surgical clipapplier according to claim 8, wherein the handle spring assemblyincludes a transverse body portion releasably retained within a proximalend portion of the housing and a pair of spring arms extending outwardlyfrom opposing sides of the transverse body portion, each spring arm ofthe pair of spring arms configured to engage a respective handle of thepair of handles to bias the pair of handles towards the spaced-apartposition.
 10. The reposable surgical clip applier according to claim 9,wherein the pair of spring arms each includes a free proximal endportion configured to slide along the respective handle of the pair ofhandles upon movement of the pair of handles.
 11. The reposable surgicalclip applier according to claim 8, wherein the handle assembly furtherincludes a linkage assembly configured to pivotably couple the pair ofhandles to the inner actuation assembly, the linkage assembly having afirst link arm configured to operably couple a first handle of the pairof handles to the proximal drive member and a second link arm configuredto operably couple a second handle of the pair of handles to theproximal pusher bar, wherein upon movement of the pair of handlestowards the approximated position, the first link arm is configured tomove the proximal drive member distally and the second link arm isconfigured to move the proximal pusher bar proximally, and wherein uponmovement of the pair of handles towards the spaced-apart position, thefirst link arm is configured to move the proximal drive memberproximally and the second link arm is configured to move the proximalpusher bar distally.
 12. The reposable surgical clip applier accordingto claim 11, wherein the linkage assembly is configured to move theproximal drive member concurrently with the proximal pusher bar uponmovement of the pair of handles.
 13. The reposable surgical clip applieraccording to claim 11, wherein the linkage assembly further includes athird link arm configured to operably couple the second handle of thepair of handles to the proximal drive member and a fourth link armconfigured to operably couple the first handle of the pair of handles tothe proximal pusher bar.
 14. The reposable surgical clip applieraccording to claim 13, wherein the proximal pusher bar is configured tomove between the first link arm and the third link arm as the proximalpusher bar moves through the proximal drive member.
 15. A reposablesurgical clip applier, comprising: a handle assembly, including: ahousing; at least one handle extending from the housing and movablerelative to the housing between a spaced-apart position and anapproximated position; and an inner actuation assembly extending fromthe housing and operably coupled to the at least one handle, the inneractuation assembly including: a proximal drive member movable throughthe housing; a proximal pusher bar movable through the proximal drivemember; and a handle spring assembly having at least one spring armengaging the at least one handle to bias the at least one handle towardsthe spaced-apart position, wherein movement of the at least one handlerelative to the housing is configured to move the proximal drive memberand the proximal pusher bar in relative opposing directions; a shaftassembly releasably engagable with the handle assembly, the shaftassembly including: an outer tube; a jaw assembly supported at a distalend portion of the outer tube; and an inner drive assembly slidablydisposed within the outer tube and operably coupled to the jaw assemblysuch that distal movement of the inner drive assembly through the outertube actuates the jaw assembly; and a clip cartridge assembly releasablyengagable within the shaft assembly, the clip cartridge assemblyretaining a stack of surgical clips therein and including: a distalpusher operably coupled to a distal-most surgical clip of the stack ofsurgical clips such that distal movement of the distal pusher loads thedistal-most surgical clip into the jaw assembly when the clip cartridgeassembly is releasably engaged within the shaft assembly; a biasingmember configured to bias the distal pusher proximally; and a clipcarrier including a pair of engagement flanges, and wherein thecartridge housing includes a pair of internal grooves extendinglongitudinally along at least a portion of a length of the cartridgehousing, the pair of internal grooves configured to laterally receivethe pair of engagement flanges, respectively, to inhibit axial movementof the clip carrier relative to the cartridge housing, wherein, when theshaft assembly is releasably engaged with the handle assembly and theclip cartridge assembly is releasably engaged within the shaft assembly:the proximal drive member is positioned proximally adjacent the innerdrive assembly such that movement of the at least one handle towards theapproximated position actuates the jaw assembly, and the proximal pusherbar is positioned proximally adjacent the distal pusher such thatmovement of the at least one handle towards the spaced-apart positionloads the distal-most surgical clip into the jaw assembly.
 16. Thereposable surgical clip applier according to claim 15, wherein the clipcartridge assembly further includes a carrier lock disposed proximallyadjacent a proximal end portion of the clip carrier, the carrier lockincluding a pair of opposing arms configured to biasingly engage a pairof opposing internal walls of the cartridge housing, wherein the carrierlock is configured to inhibit proximal movement of the clip carrierrelative to the cartridge housing beyond the carrier lock.